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Pilonidal Sinus – Causes, Symptoms and Treatment

A pilonidal sinus is a chronic skin condition near the tailbone in which a small channel forms under the skin, often leading to inflammation and abscess formation.

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Things worth knowing about "Pilonidal Sinus"

A pilonidal sinus is a chronic skin condition near the tailbone in which a small channel forms under the skin, often leading to inflammation and abscess formation.

What is a Pilonidal Sinus?

A pilonidal sinus is an acquired condition of the skin and subcutaneous tissue located in the natal cleft (the groove between the buttocks near the tailbone). It involves one or more small channels (sinuses) that form beneath the skin and often contain hair and debris. These channels can become infected, fill with pus, and lead to a painful abscess. The condition most commonly affects young men between the ages of 15 and 35.

Causes

The exact cause of pilonidal sinus is not fully understood, but several contributing factors have been identified:

Ingrown hairs: Broken hairs can penetrate the skin under mechanical pressure, triggering a foreign body reaction.
Mechanical friction: Prolonged sitting, rubbing, and pressure in the natal cleft contribute to development.
Excessive hair growth: Individuals with dense hair in the tailbone area are at increased risk.
Obesity: A higher body mass index (BMI) is a recognized risk factor.
Genetic predisposition: Familial clustering has been observed.
Sweating and poor hygiene: These can promote the development of the condition.

Symptoms

A pilonidal sinus may remain symptom-free for a long time. Typical complaints arise during an acute inflammation or abscess:

Pain and tenderness in the tailbone area
Swelling and redness in the natal cleft
Discharge of pus or fluid from one or more openings (fistulas)
Unpleasant odor from the discharge
Occasional fever in cases of severe infection

Diagnosis

Pilonidal sinus is usually diagnosed clinically through a physical examination by a physician. Typical findings include:

Visible openings (pits) in the tailbone area from which hair or fluid may protrude
Tenderness and palpable induration on examination
An ultrasound scan may be used to assess the extent of the sinus tract
In complex cases, MRI (magnetic resonance imaging) may be used for further evaluation

Treatment

Acute Treatment

For an acute abscess, immediate surgical incision and drainage of the pus is the treatment of choice. This procedure is typically performed under local anesthesia on an outpatient basis and provides rapid pain relief.

Surgical Procedures

To prevent recurrence, further surgery is usually required after the acute phase. Available techniques include:

Excision with open wound healing: The sinus is completely removed and the wound is left open to heal. High safety profile but longer healing time.
Excision with primary closure: The wound is sutured closed after excision. Shorter healing time but a slightly higher recurrence rate.
Plastic reconstructive techniques (e.g., Limberg flap): Skin flaps are rearranged to cover the wound. Lower recurrence rates, suitable for extensive cases.
Minimally invasive procedures (e.g., SiLaC, EPSiT): Laser- or endoscope-assisted methods using small incisions with faster recovery.

Non-Surgical Measures

In early or mild cases, consistent hair removal (shaving, laser epilation) in the tailbone region may help prevent progression of the disease. Antibiotic therapy alone is generally insufficient for long-term cure.

Aftercare and Prevention

After surgery, regular wound check-ups are important. To prevent recurrence, specialists recommend:

Regular hair removal in the tailbone area
Good hygiene and skin care
Weight management in cases of obesity
Avoiding prolonged sitting without breaks

References

Ommer A. et al. – S3 Guideline Pilonidal Sinus Disease, German Society of Coloproctology (DGK), AWMF Register No. 081-009, 2020.
Stauffer VK et al. – Different approaches for the treatment of pilonidal sinus disease. Journal of Visceral Surgery, 2018.
Doll D. – Pilonidal Sinus Disease. Springer Verlag, 2018.

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